Myeloma Outcomes of Black Veterans Differ from Non-Veterans

Myeloma is the most common type of blood cancer in African Americans, yet according to national data from the Surveillance, Epidemiology and End Results (SEER) database, this patient population tends to have worse outcomes and are not as likely to receive the newest treatments.

However, that is not the case in every treatment setting, as outlined in recent research presented at the 2018 American Society of Hematology (ASH) Annual Meeting.

Researchers used the Veterans Health Administration (VHA) Central Cancer Registry to identify 4,805 veterans with myeloma between 1999 and 2014, including 1,418 (29.5 percent) who were black.

In contrast to what SEER data suggests, black patients treated through the VHA had similar outcomes as other ethnicity groups. In fact, their average survival was about two months longer than non-black patients.

African Americans underwent stem cell transplantation at similar rates (12.3 percent vs. 14.2 percent), as well as treatment with agents such as Revlimid (lenalidomide; 35.1 percent vs. 36 percent), Thalomid (thalidomide; 36.7 percent vs. 38.7 percent) or Evomela (melphalan; 32.7 percent vs. 34.8 percent). More black patients were treated with Velcade (bortezomib) than non-black patients (50.1 percent vs. 44.4 percent).

Fewer treatment disparities might be the result of the VHA being a more integrated health care system — there are no premiums for coverage, no copays for medicine based off need and transportation is often provided for patients, Martin W. Schoen, M.D., MPH, of the Saint Louis School of Medicine, explained while presenting his team’s findings.

“I just want to highlight how the VA data differs from SEER Medicare data, where there were disparities found in treatment between the two populations,” said Schoen. “In summary, black patients have better outcomes in an integrated health delivery system with more uniform access to care. In our VA dataset, we really did not find evidence of disparities in treatment.”

In contrast, another study presented by Schoen at the meeting found the opposite for patients with chronic lymphocytic leukemia (CLL) — black patients treated for the disease through the VHA tended to have worse outcomes than their non-black counterparts.

“So, it does not seem to be an across-the-board effect,” Schoen said.

Even in the myeloma group, there were some differences. Notably, black patients were diagnosed with myeloma at a younger age than total population average (66 years vs. 68 years, respectively), and they also presented with more comorbidities.

“I think that our data, as well as that from other groups, supports differences in disease biology between blacks and non-blacks, in that the black population in our study present earlier in ages and have more comorbidities,” Schoen said.

The researchers said that their findings present a need for more studies like theirs, that may ultimately lead to closing the gap in care between different populations.

“We really want to highlight how treatments need to be incorporated into outcomes models to help understand these complex interactions between race, patient characteristics and treatment. Overall health care needs to improve access to care and reduce barriers in order to have better outcomes for our patients.”